San Francisco Doctors Call for Urgent Public Health Response to Overdose Epidemic

About a dozen physicians and overdose prevention advocates rallied on the steps of San Francisco’s Chief Medical Examiner’s office on Tuesday, demanding that the government do more to address the city’s overdose epidemic.

Tuesday’s action comes as San Francisco continues to face a surge in overdose deaths, largely driven by fentanyl, an opioid about 50 times stronger than heroin. More than 3,000 people have died from accidental drug overdose in San Francisco since January 2020, including more than 200 in 2024 alone, according to data from the Office of the Chief Medical Examiner.

“Three thousand deaths is an inconvenient truth. This highlights 3,000 failures and highlights how we are not listening to policy experts and doctors,” said Dr. Dan Ciccarone, who specializes in addiction medicine at the University of California, San Francisco, outside the medical examiner’s office near the Hunters Point neighborhood.

City leaders have rolled out several different interventions targeting the crisis in recent years. Efforts included a short-lived safe consumption site in 2022, along with increased distribution of drug test strips and opioid overdose reversal medicine called Narcan. The city has also opened additional behavioral health beds and supportive step-down housing.

Experts on Tuesday pointed to how overdose rates in San Francisco rapidly increased shortly following the closure of the Tenderloin Center, the drop-in social services center and safe consumption site that operated in Civic Center for nearly 10 months. There, more than 300 overdoses were reversed, and no deaths occurred.

“The fact that the Tenderloin Center closed after nine months is a crying shame,” Ciccarone said.

He added that a similar site in Melbourne, Australia, faced similar pushback from conservatives and business leaders. However, it became an accepted and embraced approach after five years of working with the community, police and other stakeholders.

Parallel to those public health interventions have been efforts to ramp up policing and other punitive approaches to the illicit drug economy. In 2023, San Francisco Police arrested more than 900 people for drug dealing in the Tenderloin and South of Market neighborhoods — double the year prior — according to city data. SFPD also made nearly 800 arrests for public intoxication and drug use in 2023.

In addition, Mayor London Breed and Gov. Gavin Newsom sent the National Guard to assist local police and the District Attorney in investigating opioid-related deaths as homicide cases last year.

“We are bringing together local, state and federal law enforcement to coordinate and hold those breaking the law in our city accountable,” Breed said in a press statement about the 2023 blitz. “We want people who need support to get help, and we will continue to offer people second chances, but San Francisco can’t be a place where anything goes and allow harmful behaviors to become the norm.”

But advocates say what’s needed are more public health-based strategies, like low-barrier treatment, affordable and supportive housing, and safe consumption services, rather than police crackdowns. On Tuesday, several said that the city’s law enforcement push has had unintended consequences that can exacerbate overdose deaths.

“We are putting people at risk, and this is a policy decision,” said Fabian Fernandez, a medical student at UCSF, at Tuesday’s rally.

Studies have shown that a person’s chances of overdose can significantly increase following an arrest and release from jail. Other critics of the city’s more aggressive law enforcement approaches say it can disrupt markets and cause some users to seek drugs elsewhere, creating opportunities for riskier use.

Speakers on Tuesday said increasing supportive housing, treatment and services like safe consumption sites have cost-savings potential, too.

One study estimates that San Francisco could save a minimum of $2.6 million if it were to offer places where people could use drugs more safely and out of the public, as opposed to downstream interventions like jail and emergency services. A 2023 study looking at the wider community impacts of a safe consumption site in New York City also found that the facility did not contribute to increased drug use or crime in the surrounding area. Instead, it offered a place for people to use drugs out of the public way more safely.

Organizations calling for more public health responses at the demonstration included the Young Women’s Freedom Center, Drug Policy Alliance, SF Public Defender’s Office, The Harm Reduction Therapy Center, HealthRIGHT 360 and the Do No Harm Coalition.

However, politics has thwarted efforts to open a safe consumption site and other approaches that public health experts call for.

In 2022, Newsom vetoed a bill that would have allowed San Francisco and two other major California cities to pilot such a facility. The initiative was part of the overdose response strategy in more than 200 places around the globe, including France, Denmark, Canada, Australia, Switzerland and others. In these facilities, people can use drugs and trained staff can reverse an overdose if it occurs while also connecting people with other health and social services.

Government and community leaders have tried to prop up a safe consumption site using private funding as well as funds from the city’s multimillion-dollar legal victory against opioid manufacturers, which states like Rhode Island have done. But those efforts have largely stalled in San Francisco, even as overdose rates have continued at epidemic levels.

“In San Francisco, we make it extremely difficult for people who are struggling with substance use disorder to find their way out and find their paths to recovery,” said Laura Thomas, senior director of HIV and Harm Reduction at the San Francisco Aids Foundation, during the rally. “We put so many barriers in people’s way, from needing to have an ID to needing to show up at a certain time of day, waitlists and restrictions … We can do better.”